People with a history of shoulder dislocations often come to see me after they have been to A&E to have the bone relocated (‘reduced’) back into the joint. Whether this is your first dislocation or the latest of many, when I first meet with you at Sulis Hospital Bath there are two main things I will want to learn; what type of dislocation was it and what caused it to dislocate? Knowing the answer to these two questions often gives me a very good idea of what may have been damaged within the joint as it dislocated.
Your age is an important factor, as evidence shows that if you dislocate your shoulder for the first time under the age of 20 you are much more likely to dislocate again in the future (and you will continue to have problems unless it is fixed).
As a shoulder specialist, I will always want to know what you ideally want to get from your treatment, as this varies for each person. For example:
Do you need to get back to your professional rugby career as quickly as possible?
Are you looking to return to sports as a hobby?
What sort of job do you have? (If you’re a plumber for example, you will probably spend a lot of time moving your arm and shoulder into awkward positions to access pipes etc., so you will need to know for certain that your shoulder is stable.)
I will also want to know whether you have any associated injuries, such as a numbness or tingling down the arm or a weakness in it that is new since the dislocation. These can be signs of nerve or tendon damage (although thankfully they are relatively rare.)
Assessing your shoulder
Once we have talked through things, I’ll carry out a thorough assessment of your shoulder. I will look to see if there's any wasting of the muscles or any change of the skin sensation that might indicate a tendon or nerve injury. I’ll also move your arm into a range of positions to test the stability of the joint.
While this physical examination is an important aspect of assessing the problem, I will also arrange a diagnostic scan to help see exactly what is going on in the joint. This will normally be an MRI scan, which provides me very detailed cross-sectional images of your shoulder joint. Occasionally, I may arrange for you to have an MRI arthrogram. For this scan, a special dye (known as ‘contrast’) is injected into your shoulder joint before you have the MRI scan. The dye highlights any damage or tears to the cartilage in the joint.
Both the scan and the physical assessment of your shoulder help me to build up an accurate picture of what the best form of treatment will be for you. If surgery is needed, the type of surgery I’ll advise will depend on a range of factors; age, number of dislocations, extent of damage within the joint etc. Of course, you will make the final decision about any treatment options.
If you have only a soft tissue injury, commonly around the rim of the socket, there is good evidence that repairing and tightening the ligaments at the front of the shoulder will help correct any instability.
Should your dislocation also have caused a loss of some bone, it may mean that the shoulder socket is now too small to properly hold the humeral head (the ‘ball’ of the ball and socket joint). I always like to explain it as being like a golf ball and a golf tee; if you lose half your tee, the golf ball with fall off it quite easily. The same is true of the shoulder, and in these cases, we would start thinking of transferring bone from elsewhere in the joint or around the shoulder region to the front of the shoulder joint to stabilize it.
Most of the time, surgery can be done as a day case procedure, meaning you will be able to return home the same day. Your arm will be in a sling for about three weeks while everything settles down and the Sulis Hospital Bath physiotherapist will help you with some gentle exercises during this time. After three weeks you will start our rehabilitation programme, which is a slow and progressive one. The aim of this rehabilitation is to slowly and safely improve your range of motion and function in the shoulder.
Around six weeks after surgery, you will be out of the sling and able to do gentle activities. Ten weeks after surgery you should be able to swim and do gentle exercise, and at 12 weeks we would expect the healing phase to be complete. You will then be able to start looking at sports-specific training again. If you play a contact sport, I tend to advise you’ll be able to return to that properly about 6 months after surgery.